Richard Ellenbogen, M.D.
National Football League Head, Neck and Spine Committee
Dear Dr. Ellenbogen:
I choose this method of communicating with you, in part, because you historically have not responded to my private emails – not to the one about the material discrepancies between your video at nflhealthandsafety.com and that of Dr. Joseph Maroon (https://concussioninc.net/?p=4308); nor to the one inquiring about the content of your presentation to the Congress of Neurological Surgeons following that group’s standing ovation for NFL commissioner Roger Goodell (https://concussioninc.net/?p=4814 and https://concussioninc.net/?p=4783).
But the main reason I’m sending this as an open letter is more basic: there is not a moment to lose this football offseason. The events of 2011-12 suggest that the coming year could be a watershed for the general public’s urgency in understanding the magnitude of the dangers of football, in general, and the serious limitations of NFL-driven solutions, in particular. Yet even without the core entertainment of weekly games, talking in a real way about the future of football at non-professional levels continues to get outmuscled by frivolous and contrived news media coverage of such meta-events as the NFL combine and upcoming draft. It is my belief that your role should include using your platform to counter this unfortunate dearth of serious discussion of a major American public-health issue. I cannot apologize if you feel otherwise.
And to be clear, I think all this goes way beyond simply improving practices within the NFL itself. The model of the pro athletes “modeling better for the kids” doesn’t work, in my view: hyper-commercial pressures inevitably lead to shortcuts, and pee-wee and high school football programs will always, by definition, lack the resources for faithful replication of the pros’ practices – even their best ones. A good example is the newly enacted hiring of on-site neurological consultants to assist with in-game return-to-play decisions. Set aside for a moment skepticism over whether this category of professionals will be truly independent, and ask yourself something more prosaic: How many public school districts could afford such a measure, on top of the many other costly ones now being mandated by the wave of state “Lystedt Laws”?
After the Colt McCoy incident in December, you told the Associated Press that you and your co-chair, Dr. Hunt Batjer, “ain’t done.” To which I say, “Great.” In addition, our mutual friend George Visger (on whose ebook autobiography I just collaborated) informs me that you accept no money from the NFL, which frees you to get to the true clinical, rather than only the client-friendly, bottom line.
With that in mind, I seek your answers to what I consider the two most important current questions relating to NFL-based correctives for the concussion crisis.
1. Independence of team physicians
Somewhat preemptively and unhelpfully, you said in your December AP interview: “Team doctors are pretty concerned about concussions, and I don’t think they’re people that are going to be bought and sold.”
I do not think, by any stretch, I am the only person who finds this observation naïve. The two-way contracts between medical groups and NFL teams – with the latter paying for doctors’ services and the former for “sponsorships” – are controversial. Do you dissent from the viewpoint that these arrangements have at least the potential to compromise medical advice and decisions? If yes, please explain why. If no, please explain what specific steps you have undertaken to address this problem in the higher councils of the NFL.
I’ve noted the interaction between professional football and amateur football health and safety practices; the commercial dependence of NFL team physicians, in my opinion, is where that interaction may find its most pernicious expression. (Advocates of retired and disabled pro players already have presented plenty of evidence of corrupt and skewed treatment and prognoses of NFL employees themselves.) For example, Dr. Howard Derman of Methodist Hospital, an official sponsored sports-medicine provider for the Houston Texans, told the Houston Chronicle, “[T]he plasticity – flexibility, in layman’s terms – in the brain is greater in a child, and it has more room to swell. So things we see in adult football players are slightly less of a concern in children.” (https://concussioninc.net/?p=5224 and https://concussioninc.net/?p=5176)
Here is someone who has failed the public by being only “pretty concerned about concussions,” whether or not there is technical evidence that he was “bought and sold.”
2. Boston’s “bold initiative” and Pittsburgh’s “game-changer”
Two days before the Super Bowl, at the NFL media center in Indianapolis, Boston’s Sports Legacy Institute – whose affiliated Boston University Center for the Study of CTE received a $1 million NFL grant – released a white paper. Co-authors Dr. Robert Cantu and Chris Nowinski called their proposal for a youth football hit count a “bold initiative.” Many critics, including myself, have characterized it far more modestly. What is your own view?
Please answer the question in the expansive spirit in which it is raised. No one is arguing that kids getting hit repeatedly, but with less frequency, would not be marginally better than kids getting hit repeatedly with more frequency. What I’m asking is whether, in your professional judgment and in good conscience, the institution of hit counts would enable you to endorse the activity of tackle football for small children and young teenagers: your own children and the children of fellow citizens.
More recently, a University of Pittsburgh Medical Center Sports Concussion Program team published an article in Neurosurgery. The study states that, thanks to proprietary tools, they are closing in on an ability to predict concussion recovery time within two days of the original injury. Micky Collins of UPMC (which, of course, is the sponsoring sports-medicine provider for the Pittsburgh Steelers) called this a “game-changer.” Others, including myself, think the study is dubious science and its promotion is irresponsible hype. What do you say?
Dr. Ellenbogen, I do not ask these and related questions with the expectation that you control every policy, every action, every utterance of the NFL and its agents and associates.
However, I do predicate this letter – which is being published on my blog, along with your response – on the belief that, as an independent doctor and researcher with a high profile in the concussion discussion, and one promoted by the league, you are obliged to disagree with the NFL, publicly and clearly, in appropriate circumstances.
Please use this opportunity to speak the full truth to America’s parents about the future of football. When good people fail to speak up, bad things follow.